Journal of Clinical and Diagnostic Research. 2023 Jan, Vol-17(1): SC10-SC15 10 10 DOI: 10.7860/JCDR/2023/56809.17291 Original Article Paediatrics Section Bedside Prognostic Indicators of Fatal Outcome among Children with Cerebral Malaria at a Tertiary Nigerian Hospital INTRODUCTION World Health Organisation (WHO) reported approximately 3.3 billion of the world population are at risk of the malaria infection. In year 2020, the estimated number of cases worldwide was 241 million and the WHO African region had about 228 million cases in 2020, accounted for about 95% of cases [1]. Severe malaria is one of the most serious infectious disease emergencies in children mostly related to Plasmodium falciparum [2,3]. It may be lethal and can lead to cerebral malaria which can rapidly progress to severe illness and lead to fatal outcome especially in children [2–4]. Cerebral malaria affects upto 1 million people per year worldwide, the vast majority being under 5-year-old children living in Sub-Saharan African (SSA) and these groups accounted for highest morbidity and mortality rates [5-7]. According to reports, cerebral malaria ranked next to severe malarial anaemia as a common complication of Plasmodium falciparum malaria in many hospitalised children [8,9]. According to previous studies, despite optimal treatment 15-22% of children accounts for deaths [8-10]. Prevalence of CM may depend on the geographic area of the study, season of the year, type of health Institution and the study design [10-12]. Studies across regions in Africa, one to two decades ago had reported major differences in the clinical manifestations and outcomes of CM in children at different ages and under different levels of malaria endemicity and patterns of transmission [10-13]. However, more emphasis needs to be placed on identifying bedside clinical and laboratory factors that could promptly and reliably detect cerebral malaria children with poor clinical outcome. Identification of bedside prognostic factors at early stage may help to reduce mortality and morbidity associated with CM. Some studies have reported different prognostic factors, but the present study formulated a bedside prognostic index score that would involve combination of different factors together so as to strongly predict poor outcome. The bedside prognostic index for CM when determined, will give a better estimate of prognosis than is possible using any single clinical or laboratory feature. These bedside indicators will be highly useful in many low- resource environments where access to optimal healthcare remains a huge task and with challenge of limitations or poor access to high technology facilities. The result of the present study is expected to aid paediatricians and all other healthcare providers to quickly recognise children with CM at risk of death or neurological sequelae so as to promptly initiate the appropriate management. Therefore, the present study aimed to formulate a bedside prognostic index score to predict poor outcome among children with cerebral malaria, especially in a low-resource community. MATERIALS AND METHODS This was a prospective, observational study conducted in the Children’s Emergency Unit (CEU) at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital Ogbomoso, Oyo State Nigeria, from February 2018 to September 2018. Informed consent was sought and only those that gave their written consent were included in the study. Ethical clearance was obtained from Ethics and Review Committee (Protocol number: LTH/OGB/EC/2017/145). Inclusion criteria: Children between the age of six months to 12 years with unarousable coma lasting more than 30 minutes in the presence of demonstrable peripheral asexual Plasmodium falciparum parasitaemia and who developed deterioration in their level of consciousness after admission were included in the study. Consecutive children with cerebral malaria, who met the WHO criteria of a patient, who could not localise a painful stimulus, who AYOBAMI OYETUNJI ALABI 1 , MICHAEL OLANIYAN ONIGBINDE 2 , AYODELE OJUAWO 3 , VICTOR IDOWU JOEL-MEDEWASE 4 , GRACE OLUKEMI ALABI 5 , OLANIKE TAYE OLADIBU 6 , BUKOLA ADETUTU SAYOMI 7 Keywords: Clinical predictive scores, Neurological sequelae determinants, Paediatric mortality trend ABSTRACT Introduction: Cerebral Malaria (CM) is a severe manifestation of malaria and commonly causes poor outcomes. It affects upto one million people per year worldwide predominantly sub-Saharan African children. It is clinically expedient that, children with CM are identified promptly and easily to halt fatal outcomes. Aim: To evaluate bedside prognostic indicators of poor outcome among children with CM. Materials and Methods: A prospective, observational study was conducted at LAUTECH Teaching Hospital Ogbomoso, Oyo State, Nigeria among children diagnosed with CM from February 2018 to September 2018. Fifty children with age range of six months to 12 years were included in the study. Outcome indicators were full recovery, alive with neurological sequelae and death. Nine of the identified clinical factors demonstrable on bedside were assigned score of 1 each and each score summated to form Bedside Prognostic Index (BPI). The median BPI Score ≥4 indicated fatal outcome. Receiver Operating Characteristic (ROC) curve validated the predictive ability of the BPI score on clinical outcomes. Chi-square test and Student’s t-test were used for statistical analysis. Results: Out of total 50 children, 30 (60%) recovered fully, 11 (22%) participants had neurological deficit(s) and 9 (18%) participants died. The median BPI score among completely recovered, survived with neurological deficit(s) and died was 8, 6 and 4, respectively. BPI score ≥4 was an independent predictor of fatal outcome {Odd’s Ratio (OR)=7.875, p-value=0.013, Confidence Interval (CI)=1.547-40.091} with sensitivity and specificity of 80% and 76.67%, respectively. The ROC of the predictive ability of BPI on clinical outcomes was 80.2%. Conclusion: Poor outcome was significantly associated with BPI of ≥4 in children with CM. The use of this scoring index should be encouraged to promptly manage children with CM at risk of poor outcome.